Call the referring provider team Monday through Friday between 8:00 a.m. and 4:30 p.m. at 866-385-3123 (1-866-DUKE-123). You can also email OncologyReferral@Duke.edu or fax 919-613-2316.
A 71-year-old male patient with a history of liver cancer presented to thoracic surgeon Jacob Klapper, MD, with a small lung nodule and an enlarged lymph node. Due to the patient’s history of liver cancer, resection of the lung nodule was recommended. Because the nodule was small, traditional robotic techniques to perform a lung resection would be challenging.
“This nodule was so small that it would be difficult to feel with the robotic instrumentation alone in a direct surgical approach, so I worked with interventional pulmonologist Coral X. Giovacchini, MD, to provide a collaborative robotic approach,” Klapper explains.
Question: What innovative procedure did Klapper and Giovacchini offer this patient?
Answer: Klapper and Giovacchini have unique expertise in performing robotic bronchoscopy and lung resection procedures together, and the patient was a good candidate. “Using the patient’s CT scan, I mapped out their airways in real time using 3D imaging techniques. Then I located the nodule and placed a small coil marker that would illuminate with the light of the surgical robot, so Dr. Klapper could very easily see the nodule and perform the robotic resection with extreme precision,” says Giovacchini.
After Giovacchini placed the coil, the patient was immediately prepped for surgery. Klapper guided the robot through small incisions in the patient’s chest. “I then turned on the light attached to the robot, and it illuminated the coil. I removed the nodule and the coil that Dr. Giovacchini inserted, and the procedure was efficient and successful,” says Klapper.
With this approach, Klapper can more precisely remove just the nodule, even if it is very small, sparing the loss of larger portions of the lung and giving patients a better quality of life long term. “This is a major benefit to patients,” says Klapper. He adds, “Small nodules don’t need big resections, so this technique allows us to remove just the nodule and surrounding tissue.”
The combined robotic bronchoscopy and robotic lung resection procedure is completed in one surgical day under general anesthesia. In the past, patients had a biopsy completed through a separate outpatient procedure, then waited for pathology results before scheduling a clinic appointment to review results and treatment recommendations. Now, treatment is expedited in a coordinated fashion. “Patients with a lung nodule see the multidisciplinary team in one clinic appointment and receive a collaborative treatment plan that day, leaving with a more streamlined surgical plan and process overall,” says Klapper.
“Having the robotic bronchoscopy and resection together saves patients time and speeds up the time to both diagnosis and potentially curative resection for patients with a suspicious or small lung nodule. This is particularly important for patients who are being treated for another cancer or are facing recurrence,” says Giovacchini.
Thoracic surgeon and surgical oncologist Hai Viet-Nguyen Salfity, MD, MPH, is also performing this collaborative resection procedure with Giovacchini, further expanding access to more patients.